Obstetric perineal trauma: An audit of training

Abstract

Summary This study aimed to establish if trainee doctors and qualified midwives have adequate knowledge of perineal anatomy, if the classification of perineal tears is consistent, and to assess satisfaction with training. Seventy-five doctors (53 registrars and 22 senior house officers of at least 6 months training in obstetrics) and 75 qualified midwives were interviewed and a questionnaire was completed. More than half the doctors and midwives who named the muscles that were usually cut during an uncomplicated episiotomy wrongly named the levator ani. There was considerable variation in the definition of a third degree tear. Less than 20 per cent of doctors and less than 48 per cent of midwives considered their training in perineal anatomy, perineal repair and recognition and repair of anal sphincter tears to be of a good standard. Although perineal repair is frequently performed by doctors and midwives, perineal anatomy is poorly understood. Under-recognised trauma and inadequate repair can lead to dyspareunia and anal incontinence, both of which can be devastating social disabilities. More intense and focused training is required.